Leg Fractures and Injuries

If your child is experiencing leg pain that just doesn’t seem to go away, a doctor may need to perform radiology tests, such as an X-ray or MRI, to help determine the cause. And if your child has started a new sport or workout plan, he may experience leg pain. Oftentimes, leg pain in growing athletes can be caused by shin splints, a femur fracture or a stress fracture. Be sure to talk to your child’s doctor if you have concerns about his leg pain.

What are shin splints?

Shin splits (medial tibial stress syndrome) are a common overuse injury among teen athletes. It causes a dull or aching pain and tenderness along the inside of the lower leg or shinbone. This condition develops gradually and causes lower leg pain in athletes, mostly those who run a lot in their sport.

What are symptoms of shin splints?

Your child may first notice the pain along the inside of the shinbone after running. Some causes of shin splints include:

• Running downhill
• Running on uneven or hard surfaces
• Improper running form
• Increasing mileage or increasing the running intensity too quickly
• Old or worn-out shoes
• Over pronation (rotation in or down of the feet) or flat feet
• Sports requiring repetitive activity, such as soccer, basketball or cross-country

How are shin splints diagnosed?

A doctor will need to examine your athlete to decide if more testing is needed to rule out other conditions. In the sports physical therapy gyms at Children’s, we conduct a thorough physical exam, which may include running on a treadmill, to look for mechanical flaws. An X-ray may be ordered to look for small fractures in the shinbones. Our sports physical therapists can show your athlete ways to properly warm up, stretch and strengthen the leg muscles to recover from shin splints and help prevent the injury from returning.

How are shin splints treated?

If your teen is experiencing shin splints, rest is important. Without taking a break from an activity, the pain can progress to occurring during and after running, and it could develop into a stress fracture. Treatment may include:

• Resting.
• Icing the shins.
• Wearing shoes with more support and cushioning. Sport orthotics (shoe inserts) may be recommended.
• Wearing a compression sleeve to warm and protect the leg.
• Doing exercises to strengthen the legs.
• Stopping activity if the pain comes back.
• Taking medication to control pain and inflammation.

When can my child return to sports after shin splints?

Typically, rest is recommended for four to six weeks after your child has leg pain as a result of a shin splint. During this time, some cross-training exercises like biking, swimming or using a low-impact elliptical machine may be allowed. When the pain goes away, activities may resume.

A femur fracture, also referred to as a broken femur, is a crack, break or crush injury in the thighbone and is very common in children. It is also referred to as a hip fracture or broken hip.

What are symptoms of a femur fracture?

• Severe pain
• Swelling and discoloration
• Inability to stand or walk
• Limited range of motion in the knee or hip

How is a femur fracture diagnosed?

At Children’s, we order X-rays, and pediatric-trained radiologists and orthopedic surgeons help diagnose femur fractures. If the growth plate is damaged, the bone can become deformed. Problems can worsen as your child grows. A damaged growth plate can also lead to limb length discrepancy, where one leg is shorter than the other.

How is a femur fracture treated?

Treatment is based on the age and size of your child, as well as the location of the fracture. Our team takes care not to damage the growth plate during treatment. Children are more likely to have long-term bone damage and hip deformities after a femur fracture, and our specialists can help prevent this.

Treatment of a femur fracture depends on:

• Your child’s age
• The pattern of the fracture
• Whether there are other injuries

In older children, surgical treatment is more common. Flexible rods or nails are placed into the hollow part of the bone, avoiding the growth plate, to hold the femur together.

4 years old or younger

If your child is 4 or younger, your doctor will likely recommend a cast for treatment. The bone is gently moved back into place and stabilized with either a Pavlik harness or a spica cast.

Spica casts are applied in the operating room when your child is asleep. This helps prevent any discomfort so the surgeon can properly fit the large cast. Your child is usually discharged from the hospital and goes home the same day. It may be necessary to make some modifications, such as adding straps to your car seat and possibly using a wheelchair if your child is too big to fit in a stroller. Our team will help you with equipment before your child is discharged from the hospital.

For a femur fracture, children typically stay in a spica cast for a total of six weeks. Once the cast is removed, your child may experience:

• Stiffness and perceived pain
• Inability to walk from a few days to a few weeks
• Walking with a limp for a few months
• Rash on the skin where the cast was removed

5 years old and older

In older children, surgical treatment is more common, and it is more dependent on the location of the femur fracture and the size of your child. Flexible rods or nails are placed into the hollow part of the bone, avoiding the growth plate, to hold the femur together. The surgery is minimally invasive, and most children recover quickly. Your child will need another surgery to remove the rods, usually nine to 12 months after the injury.

Other times, a plate is used to fix the fracture, or a rod may run the length of the femur bone.

What is a femur physis (growth plate) fracture?

Fractures can occur in either the distal (bottom) physis or proximal (top) physis and are rare. The top growth plate is located between the head and neck of the femur bone. The concern with this type of fracture is a permanent loss of blood supply to the hip joint that can result in avascular necrosis (bone tissue death).

Fractures to the bottom growth plate require a great amount of force to occur, such as direct blow from a soccer collision, football tackle or getting hit by a car. The main concern is permanent growth problems, and the risk increases with the severity of the injury. Approximately 50% of children may suffer from some type of growth problems as a result of this injury. If only a portion continues to grow, there can be a difference in limb length when your child is fully grown, and the bones could be crooked.

A stress fracture of the upper thighbone, or femoral neck, is the result of repetitive stress from weight-bearing activities. This causes breakdown or absorption of the bone. Normally, the bone is able to repair itself, but with excessive activity, the rate of bone absorption exceeds the rate of repair, resulting in a stress fracture.

Stress fractures occur most commonly in long-distance runners. There is an increased risk of this injury in females, especially those with the female athlete triad, which includes disordered eating (not eating enough calories), menstrual irregularities (irregular periods) and osteoporosis.

What are symptoms of a stress fracture?

Signs of a stress fracture may include:

• Decreased hip motion
• Pain during motion
• Groin pain
• Limping
• Tenderness

How is a stress fracture diagnosed?

Diagnostics may include:

• A complete medical history and physical examination
• An MRI
• An X-ray

How is a stress fracture treated?

Every injury is different, so your child’s doctor will create a treatment plan specialized for his needs. Treatment of a stress fracture may include:

• Rest
• Restricted weight bearing
• Surgery to insert metal screws that will help stabilize and strengthen the weakened bone to allow proper healing (screws are left permanently in place)